Project: Ghana Emergency Medicine Collaborative Document Title: Selected E.N.T. Emergencies Related to Sepsis Author(s): Jim Holliman (Uniformed Services University), MD, FACEP, 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content. For more information about how txo cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1
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GEMC: Selected E.N.T. Emergencies Related to Sepsis
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Project: Ghana Emergency Medicine Collaborative Document Title: Selected E.N.T. Emergencies Related to Sepsis Author(s): Jim Holliman (Uniformed Services University), MD, FACEP, 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content. For more information about how txo cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
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Signs of Potentially Dangerous Complications of Acute Sinusitis
ƒ Periorbital, frontal, or cheek edema ƒ Proptosis
ƒ Manifestation of orbital abscess ƒ Ophthalmoplegia ƒ Ptosis ƒ Diplopia ƒ Meningeal signs ƒ Neuro deficits of cranial nerves II to VI
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CT scan showing fluid with pockets of air in frontal air cells from frontal sinusitis in a six year old male
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Source undetermined
CT scan showing orbital & brain abscesses from ethmoid sinusitis
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Source undetermined
CT scan showing epidural abscess from frontal sinusitis (six year old male with headache, emesis, and fever)
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Source undetermined
Subdural abscess from frontal sinusitis
10 Source undetermined
Surgical drainage for same patient in prior slide
11
Source undetermined
Patient with bony destruction from frontal sinus abscess 12
Source undetermined
Coronal CT scan showing left ethmoid opacification and displacement of globe by intraorbital mass (patient was a 2 year old male presenting with fever, proptosis, and left orbital cellulitis) 13
Source undetermined
Patient with left orbital abscess 14
Source undetermined
CT scan of same patient with left orbital abscess 15
Source undetermined
Another patient with right retro-orbital abscess 16 Source undetermined
Preseptal cellulitis (important to differentiate from orbital abscess ; Use facial CT to do this)
These patients should be admitted and receive IV and topical antibiotics
17
-tripp-, flickr
Source Undetermined
Antibiotics to Consider for Rx of Sinusitis Complications
ƒ Ceftriaxone 1 gm IV q 12h ƒ Cefotaxime 2 gm IV q 4h ƒ Ceftizoxime 4 gm IV q 8h +
1 gm q 8h or chloramphenicol ( for PCN - allergic patients)
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Acute Mastoiditis ƒ Uncommon now due to antibiotic use for otitis media ƒ Most common causative bug is Strep pneumoniae ƒ Rx is IV antibiotics, myringotomy, & drainage ƒ Mastoidectomy for resistant or complicated cases ƒ Related serious problem is Necrotizing External
Otitis (or “Malignant External Otitis”) ƒ Usually caused by Pseudomonas ƒ Requires IV antibiotics for 4 weeks and radical surgical debridement
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Child with acute mastoiditis from concurrent otitis media
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Source Undetermined
Source Undetermined
Acute Chondritis ƒ Can be complication of ear piercing ƒ Most commonly caused by Pseudomonas
but can be due to Strep or Staph ƒ Requires IV antibiotics ƒ Also needs incision, drainage, and
pressure dressing if abscess present
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Patients with acute chondritis
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Source undetermined
Mucormycosis ƒ An aggressive opportunistic fungal
infection usually with Mucor or Rhizopus ƒ Occurs in immunocompromised and poorly
controlled diabetic patients ƒ Mortality 30 to 70 % ƒ Requires IV and topical amphotericin B and
aggressive surgical debridement
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24
Source Undetermined
Source Undetermined
25
Source undetermined
32 year old diabetic presented with coma and DKA ; the hard palate was necrotic with mucormycosis 26
Source undetermined
Peritonsillar Abscess ƒ Complication of acute tonsillitis ƒ Unilateral peritonsillar and soft palate swelling
with uvular deviation ƒ Most commonly caused by Strep species but
can be polymicrobial ƒ Usually have trismus, drooling, muffled “hot
potato” voice ƒ May need CT to r/o parapharyngeal abscess ƒ Requires antibiotics, needle aspiration, and
voice ƒ Need CT to r/o parapharyngeal abscess ƒ Rx : IV ceftriaxone, +/- airway control 39
Plain film showing enlarged epiglottis from epiglottitis in an adult
40 Source undetermined
Acute epiglottitis in a 66 year old male
41 Source undetermined
CT scan of same patient as on prior slide ; note column of air around the epiglottis (E) ; the right side of the epiglottis is more swollen than the left ; hypo-attenuation at “A” is suggestive of early abscess
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Source undetermined
E.N.T. Emergencies Related to Sepsis : Lecture Summary
ƒ Maintain low threshold for workup with facial CT, particularly in immunocompromised patients
ƒ Start IV antibiotics early ƒ Don’t forget routine resuscitative measures (such as
IV fluid bolus) and blood cultures in febrile or toxic patients
ƒ Early consultation with your friendly otolaryngologist ƒ May require additional consults to neurosurgery or ophthalmology ƒ Use consultant to decide if pre-operative needle aspirates for culture